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From risk to results: Multi-arterial coronary bypass approaches in high-risk cohorts

Alexandra N Schwann1, Irbaz Hameed1, Thomas A Schwann2

  • 1Yale-New Haven Hospital, New Haven, CT, USA.

Asian Cardiovascular & Thoracic Annals
|May 14, 2026
PubMed

Insights

Multi-arterial bypass grafting offers improved outcomes over single-arterial methods in general surgery. This review examines its survival benefit in high-risk patients, considering bilateral internal thoracic arteries and left internal thoracic with radial artery grafts.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Vascular Surgery

Background:

  • Multi-arterial bypass grafting (MABG) demonstrates improved patient outcomes compared to single-arterial bypass grafting (SABG) in general surgical revascularization.
  • The survival benefit of MABG in high-risk patient sub-cohorts remains less defined, questioning its increased technical complexity.

Purpose of the Study:

  • To review current evidence on MABG versus SABG in higher-risk patient cohorts.
  • To discuss the value of MABG in specific patient populations undergoing surgical coronary revascularization.

Main Methods:

  • Review of current evidence comparing MABG and SABG in high-risk patients.
  • Focus on bilateral internal thoracic arteries (BITA) and left internal thoracic artery (LITA) with radial artery (RA) grafts.

Main Results:

  • Evidence suggests MABG may offer survival benefits in certain high-risk groups, though further research is needed.
  • The technical aspects and graft choices (BITA, LITA+RA) influence outcomes.

Conclusions:

  • MABG may be advantageous in select high-risk patients, justifying its complexity.
  • Choosing appropriate MABG techniques is crucial for optimizing surgical coronary revascularization outcomes.

Keywords:
CABGCoronary artery bypass graftsarterial graftscoronary artery disease (pathology, pharmacology, physiology, etc.)outcomes (including mortality, morbidity, survival, etc.)revascularization (specify organ or tissue)

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